Paul Jacob

It’s often difficult to know where ideology ends and realpolitik begins.

Politicians claim to be pure partisans of principle alone — “statesmen,” to use the old-fashioned term. But observe their behavior and quickly their personal and professional interests shake out of their sleeves.

With the medical industry reform bill now almost universally known by Democrats as, simply, “the health care law” (as if there weren’t a thousand other such laws also dictating on aspects of health care) and by everyone else as, more simply yet, “Obamacare,” the game-playing and ideological posturing have become even more convoluted than usual.

But I’m prepared to take former House Speaker and current House Minority Leader Nancy Pelosi almost at her word. Before the bill was passed, she notoriously said we had to “wait to see what’s in” the law. Now that the law has started kicking into effect, stage by stage, she says that she is quite happy with the reforms. Indeed, “all” Democrats are!

We saw an opportunity to stand with those who created Social Security, Medicare and Medicaid in the ’60s, and now our generational opportunity to have health care as a right — not a privilege. And that is what we came here to do. . . .

Her “right not a privilege” meme tips her left hand. Folks who see society in terms of institutional authority look at good things we get either as coerced, by legal right, or granted by “special privilege.” Those of us who see society as importantly made up largely of voluntary arrangements don’t look at the bulk of what we get as the result of “privilege” but, instead, as legitimate gains from honest trade. In my view, anyway, my health care is my responsibility, not your obligation. When you demand something as your right, it entails obligations on others.

So that’s Pelosi’s ideological play.

Her political play becomes clear in her next breath:

We think the more people know about this legislation, you see it has changed even in the past week, the support for it has increased and as people understand what we all heard here today — how it affects their lives directly — that will even grow. So as I’ve said before, the politics be damned — we came to do a job. We’re very proud of what we did.

From the very beginning, Democrats have counted on a very old strategy, that of relying on perceived benefits and obscured costs while kicking in measures piece by piece, allowing time for the proverbial frog to boil. In too many government programs, the benefits pop out, obvious and immediate, while the costs remain under cover, obscure and remote. When someone gets a new benefit from a program, they notice it. But it’s harder to notice the costs associated with it. Costs are often borne by others, or borne by oneself in some unexpected way, such as by a seemingly unrelated tax, or by loss of wealth due to inflation — which is itself caused by borrowing to avoid immediate hikes in tax rates.

Another way to hide costs is to regulate. In medical reforms, government “regulation” in the form of “mandates” for insurance companies increases those companies’ costs, so, in order to keep in business, they raise rates. But insurance buyers rarely blame the government program that forced the rate increases; they naturally blame the insurance companies. And so government must “step in” to further offset the “market failure” of cost inflation, even if the bulk of those costs are the result of government itself.

It’s obvious that Pelosi doesn’t care . . . about the increased costs. She has a hunch, a political sense, that folks won’t notice her hand on all that will go wrong. Instead, she’s betting on what seems like a long shot, that the damage her bill will do will accrue neither to the bill nor to herself. It will be blamed on doctors, or lawyers, or insurance companies or middlemen, or even the president — anyone but her.

Her strategy rests entirely on enough voters perceiving the near-term benefits before “too many” voters perceive the long-term mounting costs.

From the beginning of the campaign for “universal coverage” and “healthcare insurance,” too few voices made the obvious demand: That government stop spoiling the insurance system with apparently well-meaning but proven disastrous requirements, mandate upon mandate. It would be a lot easier for the young and the poor to buy medical insurance — and thus more closely approach universal coverage — if the costs weren’t so artificially high. And the costs wouldn’t be so high were government less meddlesome.

But that fix almost never gets mentioned.

No surprise why. Such a common-sense standard asserts a personal responsibility for one’s own health, and Democrats don’t get elected by pushing responsibility. They get elected by increasing one’s “entitlements” — and so we now have a new entitlement program. Obamacare, where our health is the government’s responsibility, not our own, where physicians and nurses are becoming public servants, and private medical insurance is slated for the chopping block.

But first things first. There’s the next election. And Democrats are proud of their “health care law.”

Republicans, of course, are almost done putting Mitt Romney on the ballot as the anti-Obamacare candidate — he, the former governor who had previously expressed pride in Romneycare, the Massachusetts prototype for the current national system.

It’s hard to know which group of partisans are the bigger fools, Democrats for enthusiastically promoting a socialistic, anti-individual responsibility system for medicine, or Republicans for less enthusiastically promoting the same thing.

Neither the play of politics nor the winds of ideological doctrine look promising. But the context is clear: We have a new entitlement system in place, ratcheting up week by week, month by month, adding costs upon costs (even if obscured), just as the old entitlement programs of Social Security (1935), Medicare and Medicaid (1965) run further into the red, on schedule to bankrupt the country.

Americans concerned about medicine are about to swallow a more bitter pill than they had planned.


Paul Jacob

Paul Jacob is President of Citizens in Charge Foundation and Citizens in Charge. His daily Common Sense commentary appears on the Web and via e-mail.